title: Pulmonary Arteriovenous Malformations in Heterotaxy Syndrome: The Case for Early, Direct Hepatic Vein-to-Azygos Vein Connection.
abstract: We report a surgical approach using hepatic vein-to-azygos vein connection without cardiopulmonary bypass or deep hypothermic circulatory arrest in a patient with heterotaxy syndrome and interrupted inferior vena cava with persistence of pulmonary arteriovenous malformations (PAVMs) after previous Fontan completion. We advocate early performance of hepatic vein-to-azygos vein connection following the Kawashima operation for heterotaxy with functionally univentricular heart and interrupted inferior vena cava. We review the physiology of heterotaxy syndrome with congenital heart disease and justify our approach in the context of a review of previous surgical strategies used in this patient population.
authors.affiliation: Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Burstein
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
authors.forename: Michael D
authors.initials: MD
authors.lastname: Puchalski
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stewart
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Blanco
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
keywords: CHD univentricular heart; Fontan; heterotaxy; pulmonary arteriovenous malformations